Att 3p: HIV Testing Brief Survey Instrument

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Documents and Forms

Document Name Document Type
Att 3p Brief Survey-HIV Testing_reinstatement_07-14-20.docx Other-WORD
Att 3p Brief Survey-HIV Testing_reinstatement_07-14-20.docx Other-WORD

Information Collection (IC) Details

IC Title:	Att 3p: HIV Testing Brief Survey Instrument	Agency IC Tracking Number:	0920-21FV

Is this a Common Form? Yes		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Att 3p Brief Survey-HIV Testing_reinstatement_07-14-20.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 213	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	213	213
Annual IC Time Burden (Hours)	53	53
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.